Management of patients following cold water immersion

Immersion in cold water is a common event. Drowning, which is defined as death caused by an impairment of respiratory function from immersion in liquid, is a major cause of death worldwide (World Health Organization, 2003). In most countries, it reflects the third most common cause of unintentional death in adults and the second most common in children, with approximately 500 000 immersion-related deaths occurring internationally every year (Bierens et al, 2002; Shattock and Tipton, 2012). In the UK there were 420 water-related deaths in 2010 with the highest number (52%) occurring in inland waters such as rivers, canals, lochs and lakes (National Water Safety Forum, 2012). With seawater temperature varying between 15–18ºC at its warmest, the threat of sudden cold water immersion in the UK is a real one. Even for those patients who survive to the Emergency Department (ED), half will require hospitalisation or transfer to further care, with non-fatal injuries resulting in neurological deficits including a permanent vegetative state (Cummings and Quan, 1999). In previous years most immersion victims were treated as drowning cases and managed appropriately. However, with the increased use of items such as the lifejacket, immersion hypothermia has become a common consideration too (Golden and Rivers, 1975). Despite this, and accidental hypothermia being associated with significant mortality and morbidity, the exact incidence of immersion hypothermia remains unknown (Brown et al, 2012). In fact, cold water immersion more generally is still thought to be poorly understood by the general public and even by many outdoor experts (Giesbrecht and Wilkerson, 2006).